Stuff Happens

So remember how we weren’t sure whether I had a hematoma when I went home from mastectomy? I did. Over the next 18 hours or so, my right side swelled to almost double the size of the left. The left breast, which was only moderately swollen, sat high and tight against my chest, looking very much like a pale, grumpy venus fly trap with mild fruit punch mouth. If you’ve ever seen Little Shop of Horrors or played Plants versus Zombies, you’ll be able to picture this just fine. But while it looked like it wanted to punch someone with its grouchy little face, it felt fine and was producing a reasonable amount of fluid, which was already turning from red to light pink. The right one looked like an over-full quart-size ziplock bag with gallon aspirations hanging from my chest, and the bag was filled with blood all along the seam and up a couple inches on each side. It looked rough and it felt rough.

A hematoma is basically a pooling of blood. Most of the time, they resolve fine on their own after a mastectomy. Well, actually, most of the time they don’t happen at all. It is one of the more common complications, but it still happens in fewer than 10% of cases – far fewer when the patient doesn’t have immediate reconstruction. Most of the time, hematomas are minor when they do happen and the body will reabsorb the blood over time. Occasionally, they just keep expanding, which increases the risk of tissue damage and infection, so the surgeon has to open the incision back up, drain the blood and fluid, wash out the site with sterile liquid, and sew you back up. That’s what happened to me. Oddly, he never did find where the bleed was coming from in my case or he’d have patched that up while he was in there, but it didn’t recur after the washout, so apparently it sorted itself in the process.

There was a lot of picture texting and debating the night I went home and the next morning, and an edict not to eat after midnight just in case. But once the decision was made, we hopped into the fancy car with the good shocks and ran up to the office. It was a quick little surgery; I think we were there maybe an hour and a half all together and I was actually under for less than 20 minutes. No nausea at all post-op and we didn’t have to hang around long after. He was able to do it at the surgery center attached to the plastic surgery office and, honestly, the most notable thing about it was the way my surgeon reacted to my having to come in at all.

“I’m so sorry,” he said, his hand on my shoulder. “I hate we’re having to do this to you.” It was clear from his tone and face that he really was sorry, that he really did feel bad.

I looked at him and shrugged as best I could. “Stuff happens.”

I wasn’t trying to be heroic or generous. It’s just true. I mean, sure complications are on the rare side, but they do happen. And it’s not as though he could have done anything to prevent it. I meet a surprising number of people who think surgeons have complete control over everything that happens in the OR – and if there’s a complication, someone must have done something wrong. Don’t get me wrong, mistakes and malpractice absolutely do occur. And as with any field, a certain subset of doctors do, in fact, suck. But most complications arise because bodies are weird. They sometimes behave unexpectedly or, even if not unexpectedly, at least in ways we might not want them to. Nothing alive is completely predictable and sometimes it just is what it is.

So yeah, neither another car ride nor another surgery, no matter how minor, were on my wish list but, as complications go, it was really just a hiccup. I felt much better afterward and I’d have likely slept that day away regardless. And it gave me another experience I can share with people, another thing I can assure folks they can get through.

It also offered yet more proof that my plastic surgeon really is a gem. Because complications do occur and I suspect most surgeons focus on that and on reassuring patients it’s not a big deal rather than taking the opportunity to acknowledge the patient experience, connect with them, and make them feel seen. When I replied that stuff happens, my surgeon gave a sad little half-nod.

“It does,” he said, “but we really try to avoid it. This is an easy fix, but cancer is tough enough as it is. We like things to go perfectly for you so you don’t have any additional stress.”

I’ve talked to other survivors who had minor complications and the response from many surgeons seems more apt to be a businesslike, semi-dismissive “well, these things happen, but it’s no big deal.” I understand that kind of response, both from the perspective of the legal team who probably encourages it and from the perspective of trying to decrease patient worry. And it is an accurate statement. But it’s pretty much guaranteed to make a patient feel insignificant – or make them hope for a bout of post-anesthesia nausea so they can throw up on the guy’s shoes.

A response that both decreases worry while also engaging the patient on a human level and offering some support and sympathy doesn’t take many more words or seconds to deliver – and it goes so much farther at a time like that than I think most medicos realize. A lot of surgeons, I’ve learned, could learn a lot from those I was lucky enough to draw.

As usual, though, I digress. My point is that speed bumps are going to happen. They’re pretty much unavoidable. So drive the mindset with the cushy seats and good shocks whenever you can. It’ll make the ride a whole lot easier.